MEDICARE: MS. COLEEN SMITH-LOUGHNEY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	005506	NY

General Provider Information

NPI Number	:	1568654515
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. COLEEN SMITH-LOUGHNEY

Provider Business Mailing Address
First Line	:	225 THUNDER HILL RD
Second Line	:
City	:	WOODBOURNE
State	:	NY
Zip	:	12788-6605
Country	:	US
Telephone Number	:	845-693-4712
Fax Number	:	845-693-4712

Provider Business Practice Location Address
First Line	:	225 THUNDER HILL RD
Second Line	:
City	:	WOODBOURNE
State	:	NY
Zip	:	12788-6605
Country	:	US
Telephone Number	:	845-693-4712
Fax Number	:	845-693-4712

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/14/2007
Last Update Date	:	08/14/2007

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